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VEEB > Complications in Labor(HD) > Flashcards

Complications in Labor(HD) Flashcards

1
Q

High Risk Pregnancy Factors:

Biophysical

A
  • Genetics
  • Nutritional Status
  • Medical/Obstetrical history
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2
Q

High Risk Pregnancy Factors:

Psychosocial

A
  • Smoking
  • Caffeine
  • Alcohol
  • Drugs
  • Psychological status
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3
Q

High Risk Pregnancy Factors:

Sociodemographic

A
  • Low income
  • no prenatal care
  • age
  • parity
  • marital status
  • residence
  • ethnicity
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4
Q

High Risk Pregnancy Factors:

Environmental

A

-Exposure to teratogens

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5
Q

Fetal Status Tests(Ultrasound)

A
  • visualizes fetal and maternal structures

- can be done transvaginaly

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6
Q

Fetal Status Tests(Amniocentesis)

A
  • done 12-20 weeks
  • genetic diseases
  • quadruple screening
  • fetal lung maturity
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7
Q

Fetal Status Tests(Non-stress test)

A
  • external fetal monitoring

- reactive vs. non-reactive

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8
Q

Maternal Testing

A

-Maternal HGC for 02
-indirect coombs, test for RH
-triple screen(16weeks):
AFB=alpha fetal protein=neural tube defects=spina bifida
HCG=increase rapidly in beginning=hormone=rise in losing pregnancy
Estriol=High=down syndrome
-Glucose Screening
-Vaginal Culture

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9
Q

Hyperemesis Gravidarum(Etiology)

A
  • a lot of vomiting during pregnancy
  • excessive and difficult to alleviate N&V
  • can happen to anyone young,old,obese,smoker
  • morning sickness=no electrolyte imbalance
  • hyperemesis=electrolyte imbalance
  • antiemetics use cautiously; not in the beginning
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10
Q

Hyperemesis Gravidarum(s/s)

A
  • weight loss
  • dehydration
  • electrolyte imbalance
  • ketonuria
  • acetonuria
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11
Q

Hyperemesis Gravidarum(tx)

A
  • Rest
  • IV fluids
  • Antiemetics use cautiously
  • severe cases-hospitalization-PPN or TPN
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12
Q

Hyperemesis Gravidarum(Nursing Care)

A
  • I&Os
  • smalls meals
  • FHR
  • VS
  • Rest
  • Assess for s/s of dehydration=poor skin turgor, dry mm, excessive thirst, dark concentrated urine
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13
Q

Incompetent cervix(Etiology)

A
  • Painless, premature dilation of cervix
  • Spontaneous abortions in obstetrical History
  • under 14weeks: not able
  • above 26weeks: age of viability
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14
Q

Incompetent cervix(Tx)

A
  • Cervical Cerclage(closing opening surgically) if cervix is dilated more than 3cm and membranes intact
  • Done between 14-26 weeks
  • non-weight bearing recommended
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15
Q

Incompetent cervix(Nursing Care)

A
  • Pt Education: explaining to mom why she should stay on bedrest
  • emotional support
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16
Q

Bleeding Disorders

A

Early Pregnancy(before 24weeks)

  • spontaneous abortions
  • ectopic pregnancy
  • hyditaform mole

Late Pregnancy(towards end of pregnancy)

  • Placenta Previa
  • Placenta Abruptio
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17
Q

Spontaneous Abortions(etiology)

A

loss of pregnancy before 20 weeks
-ruptured membrane 24-36hrs for fetal survival
-remaining tissue parts can lead to hemorrhage/infection/death
D & C=dilate cervix and move excessive tissue

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18
Q

Spontaneous Abortions(Threatened)

A

-vaginal bleeding, closed cervix, mild cramps

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19
Q

Spontaneous Abortions(Inevitable)

A

-cervical dilation, ruptured membranes, vaginal bleeding

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20
Q

Spontaneous Abortions(Complete)

A
  • products of conception expelled
  • uterine contractions
  • bleeding
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21
Q

Spontaneous Abortions(Incomplete)

A
  • profuse bleeding, retained tissue parts

- need D&C surgery to remove tissue parts

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22
Q

Spontaneous Abortions(Missed)

A

-fetus dies but retained, amenorrhea, foul smelling discharge or bleeding

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23
Q

Spontaneous Abortions(Septic)

A

-infection of uterus

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24
Q

Spontaneous Abortions(Habitual)

A

-3 or more consecutive loss of pregnancies

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25
Q

Spontaneous Abortions(Tx)

A
  • Threatened-bedrest
  • other-IV oxytocin(cause contraction)
  • D&C
  • Vacuum evacuation
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26
Q

Spontaneous Abortions(Nursing Care)

A
  • vs
  • I&O
  • risk for hemorrhage
  • Rhogam if Rh negative
  • Emotional Support
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27
Q

Ectopic Pregnancies

A
  • fertilization not in uterus
  • not occupying uterine cavity
  • increase w/ std’s
  • ruptured appendix
  • endometrosis
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28
Q

Ectopic Pregnancies(S/s)

A
  • abd tenderness
  • spotting
  • bleeding
  • decrease H&H
  • increase WBC
  • shoulder pain
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29
Q

Ectopic Pregnancies(Dx and Treatment)

A
  • Trans Vaginal ultrasound
  • methotrexate(antineoplastic; attack growth of cell)
  • Salpingectomy(salpingectomy=salpinge aka removal of fallopian tube)
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30
Q

Ectopic Pregnancies(Nursing care)

A
  • monitor s/s shock
  • pre & post op care
  • grief counseling
  • pregnancy counseling
  • monitor HCG levels
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31
Q

Hydatiform Mole(molar pregnancy)(Etiology)

A
  • Abnormal trophoblastic tissue-avascular vesicles

- complete or incomplete

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32
Q

Hydatiform Mole(S/s)

A
  • abnormal uterine growth
  • PIH(pregnancy induced hypertension)
  • HCG level
  • excessive N/V
  • vaginal bleeding
  • no heartbeat
33
Q

Hydatiform Mole(Dx and Tx)

A
  • Transvaginal ultrasound
  • D&C=dilation and curclage=scraping of wall of uterus
  • rhogam
34
Q

Hydatiform Mole(Nursing Care)

A
  • assess for infection and hemorrhage
  • patient education
  • emotional support
35
Q

Placenta Previa(Etiology)

A 
-abnormal placement of placenta
Types:
-marginal=on side
-partial=covering part of internal os
-total=everything upside down, entire os is covered
36
Q

Placenta Previa(S/s)

A

PAINLESS bleeding in 3rd trimester**

-goal for pt to reach 34 weeks=lung development

37
Q

Placenta Previa(Tx)

A
  • bedrest=no pressure of fetus on placenta

- C-section=possible vaginal delivery with marginal=requires C-section except possibly a marginal

38
Q

Placenta Previa(Nursing Care)

A
  • monitor FHR
  • assess for hemorrhage
  • assess fundus(bleeding behind fetus)
  • emotional support for family
39
Q

Abruptio Placentae(etiology)

A
  • premature separation of placenta
  • caused by physical/emotional trauma/car accident/fall down stairs/
  • PIH(pregnancy induced hypertension)
  • h/o abruption
  • smoking/cocaine
  • PROM(premature rupture of membrane)
40
Q

Abruptio Placentae(s/s)

A
  • PAIN**
  • vaginal bleeding
  • fetal distress
  • hard uterus
  • maternal shock

potential for:

  • maternal shock/death
  • fetal brain damage
  • fetal demise
41
Q

Abruptio Placentae(Tx)

A
  • CBR-complete bed rest
  • FHR
  • Moms VS
  • C/section
42
Q

Pregnancy Induced Hypertension(Toxemia)

A
  • PIH=after 20weeks
  • no proteinuria
  • B/P= increase 140/90
  • increase of 30mm systolic
  • increase of 15mm Diastolic

TX:

  • monitor closely
  • rest
  • low salt diet
  • high bp after 20weeks of pregnancy
  • any mother w/Bp 140/90=PIH
  • if increase of 30mm systolic=PIH
  • increase 15mm diastolic=PIH
43
Q

Pre-Eclampsia

A

-mild, severe
-HTN after 20weeks
-s/s=proteinuris edema of hands and face
-headache, blurry visiom
-damage to epithelium lining of vessels due to decrease in blood supply
-can lead to HELLP syndrome
HEMOLYSIS
ELEVATED LIVER ENZYMES
LOW PLATELETS
-elevated liver enzymes=increase in ammonia, not enough o2 to fetus

44
Q

Pre-eclampsia(mild)(TX)

A

-limit activity
-possible complete bed rest lying on back or side lying
-anti-hypertensive
-pt education-often pt feels fine
-

45
Q

Pre-eclampsia(Severe)(TX)

A
  • hospitalization
  • antihypertensive(concerned with hypotension)
  • MagSO4=classic drug for eclampsia, decrese smooth muscle of body
  • calcium gluconate=antidote for MagSO4
  • Lasix=makes urine frequent, given because risk of fluid overload
  • Amniocentesis=done in late pregnancy to see lung development
  • decrease incidence of seizures as a preventative, prophalatic
46
Q

Eclampsia(Etiology)

A
  • s/s pre-eclampsia w/ SEIZURES
  • p/f abruption
  • fetal compromise, fetal death, maternal death
47
Q

Eclampsia(S/S)

A
  • seizures
  • HTN, proteinuria(Large and excessive)
  • decrease urine output, increase BUN and creatine(toxic)
  • decrease platelets(lead to bleeding)
  • visual problems(temp. blind)
  • pulmonary edema(fluid in lungs)
  • put on dialysis/ventilator
48
Q

Eclampsia(Tx)

A
  • multiple antihypertensive
  • MagSO4=drug of choice for pre-eclampsia=can cause loss of deep tendon reflex
  • excreted by kidneys must have good urine output and renal function
  • give calcium gluconate if loss of deep tendon reflex
  • foley in if less that 60cc/hr
  • below 30cc/hr=stop magnesium sulfate
49
Q

Eclampsia(Nursing care)

A
  • quiet room
  • VS
  • I&O
  • FHR
  • increase protein diet
  • monitor deep tendon reflexes
  • side position
  • seizure precaution(padded bedside, suction machine)
  • suction at bedside
  • emotional support
  • mom Is at risk up to 48hrs after delivery
50
Q

Blood incompatibility(ABO incompatibility)

A
  • ABO incompatibility
  • Mom=O(contains anti-A and Anti-B Antibodies)
  • Fetus= A or B
  • cause jaundice or hepatosplenomegaly
51
Q

Blood incompatibility(Rh incompatibility)

A
  • Mom=Rh-
  • Fetus=Rh+
  • leakage of antigens can occur during delivery
  • first pregnancy no difficulty
  • subsequent pregnancy antibodies attack
52
Q

Blood incompatibility(Treatment)

A
  • Rhogam(immunoglobulin) 72hrs after delivery
  • may be given at 28weeks gestation
  • pathological jaundice
  • Rh (-) mother Rh (+) baby= problem
  • rh- mom given rhogam
  • given @28weeks and again 72hrs after birth
53
Q

Gestational Diabetes(Etiology)

A

-abnormal metoblism caused be need for more insulin and increase in hormone(HPL)

54
Q

Gestational Diabetes(s/s)

A
  • rapid weight gain
  • increase surgar in urine
  • increase sugar in blood
  • potential for DKA
55
Q

Gestational Diabetes(effect on fetus)

A
  • macrosomia

- neonate hypoglycemia

56
Q

Gestational Diabetes(Tx)

A
  • insulin
  • daily bs
  • frequent monitoring
  • possible c-section
57
Q

Gestational Diabetes(nursing care)

A
  • pt education/nutrition

- usually resolves after delivery

58
Q

Sickle cell

A
  • avoid crisis
  • potential for MI
  • CVA
  • PE during labor
  • needs 02
59
Q

Anemia

A
  • monitor H/H
  • iron supplement
  • incerase iron diet
60
Q

Cardiac

A
  • maintain B/P
  • limit activity during labor
  • usual c-section
61
Q

Infection

A
  • cultures

- c/section to avoid transmission during delivery

62
Q

Dystocia

A

-prolonged labor
-freidman curve:
used to graph dilation n descent
-potential problems:
infection
postpartum hemorrhage
exhaustion of mother
-can be related:
power-contraction
postiton of fetus
presentation of fetus
size of fetus

63
Q

Dystocia related to contractions

Hypotonic

A

-weak ineffective contractions in active phase
-failure to progress contractions
treatment:
-amniotomy
-iv Pitocin(oxytocin)=increase uterine contractions
-possible c/section

64
Q

Dystocia related to contractions

Hypertonic

A

-frequent strong contractions=uncoordinated in latent phase
treatment:
-sedative or medication to relax uterus
-brethine-relax smoothe musle of lung
-Procardia-regulate contraction of uterus
-MgSo4=drug of choice for eclampsia causes deep muscle tendon relax
-calcium carbonate is the antidote

65
Q

Dystocia related to position,size,presentation:

Abnormal position

A
  • posterior
  • severe back pain
  • may need forceps
  • can rotate to normal position
66
Q

Dystocia related to position,size,presentation::

cephalopelvic disproportion

A
  • head too large or pelvis too small
  • trial labor
  • monitor bladder
  • possible c/section
67
Q

Dystocia(Macrosomia)

A
  • large baby over 10lbs
  • frequently with diabetic mother
  • episiotomy, possible c/section
68
Q

Dystocia(Abnormal Presentation/Breech):

A
  • will try external version
  • potential prolapsed cord and aspiration
  • possible c/section
  • (face)interferes with normal mechanism
69
Q

Precipitous Labor

A
  • completed within 3 hours
  • strongs, frequent contractions
  • potential fetal distress, perineal lacerations and hematomas
  • precipitous delivery= multipara, do not leave alone
70
Q

Induction of Labor

A
  • stimulating labor before it naturally starts
  • augmentation(adding)-accelerates or helps labor after it has started
  • prostaglandins-cervival gel
  • Laminaria-dried seaweed
  • nipple stimulation, oxytocin from posterior pituitary
  • walking-stimulates descent
71
Q

Induction of Labor

A
  • given in microdrops
  • oxytocin: 10units/1000cc ringers
  • stimulates uterine contractions
72
Q

Induction of Labor(s/s of overstimulation)

A
  • contractions closer than q2mins
  • longer than 90sec=fetal distress
  • rest less than 60sec=fetal distress
  • possible fetal distress
  • rupture of uterus
73
Q

Induction of Labor(Contraindications)

A
  • placenta abnormalities(placenta abrupt(premature rupture of placenta),placenta previa(misplaced placenta)
  • abnormal presentations
  • prolapsed cord
  • fetal distress
  • prior c/section with classic or low vertical incision
74
Q

Amniotomy

A

-artifical rupture of membranes to stimulate or augment labor
-potential complications
umbilical cord prolapse
infection
abruption
Nursing Care:
-FHR
-monitor moms VS
-check amniotic fluid

75
Q

Premature rupture of membranes

A
  • before labor starts naturally and after 38weeks
  • guidelines for premature rupture of membrane(72hrs or signs of infection fever 101F or higher)
  • possibly caused by infection(chorioamnionitits or group B strep)
  • Nursing Care:
  • check pH of vagina using Nitrazine paper
  • monitor VS
  • Bedrest
  • monitor Fetal status
76
Q

Pre-Term Labor(Etiology)

A
  • cervical changes after 20 weeks and before the end of 37 weeks
  • low socioeconomic status
  • young mother
  • incompetent cervix
  • poor nutrition, stress
  • decrease blood supply to uterus
  • abdominal trauma
  • polyhydramnios(excess amniotic fluid in amniotic sc)
77
Q

Pre-Term Labor(Nursing Care)

A
  • Bedrest
  • IV hydration
  • tocolytics: to relax uterus and stop contractions
  • betamethasone: to hasten fetal maturity and increase surfactant production in fetus
  • care of infant-NICU-given surfactant to keep alveoli open to prevent RDS
78
Q

Post term pregnancy

A

-pregnancy last longer than 42 weeks
-decrease placental perfusion risk of decrease 02 to the fetus
-may pass meconium
-decrease in amniotic fluid
-fetus keeps gaining weight
Nursing care and treatment:
-induction of labor
-c.section

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